Figure 1 Delayed enhancement sequence
at the same orientation and location as Movie 3.
Note the very focal bright region of enhancement (arrow)
in the subepicardial (non-CAD pattern) region

Figure 2 Delayed enhancement sequence
at the same orientation and location as Movie 2 (3-chamber view).
Note the very focal bright region of enhancement (arrows)
in the basal infero-lateral wall matching the wall motion abnormality

Delayed enhancement images after gadolinium confirmed the presence of a focal fibrosis matching the wall motion abnormality previously described (Figures 1 & 2). There also appeared to be fibrosis involving a large segment of the thickened atrial wall (Figure 3).

Cardiac sarcoidosis is an underdiagnosed disease as it may be asymptomatic despite pulmonary involvement. Furthermore, it may be the presenting feature of sarcoidosis - as in our case - with a cited prevalence of 20% to 25%.1Cardiac involvement may be present in the absence of any abnormality on standard cardiac testing and CMR is becoming the noninvasive diagnostic imaging technique of choice for evaluation and diagnosis of suspected cardiac sarcoidosis. 2
Mitral regurgitation (MR) may occur in the setting of cardiac sarcoidosis due to associated systolic dysfunction and left ventricular dilation or due to papillary muscle involvement by sarcoid granulomas 3. Focal involvement of the infero-lateral wall associated with left artial involvement likely also contributes to the MR.
Cardiac sarcoidosis should be considered in patients presenting with unexplained mitral regurgitation. Our review of the literature suggests this is at least the 4th reported case of cardiac sarcoidosis presenting as mitral regurgitation.
CMR could be considered in all non-ischemic mitral regurgitation where the etiology of mitral regurgitation is not clear. In this case, CMR added information over and above the surgical biopsy of the left atrium

Have your say: What do you think? Latest posts on this topic from the forum

Re: Number 11-02: Another cause of mitral regurgitation
Quite nice case indeed;I was wondering whether she had evidence of thoraric sarcoidosis and if she had history of atrial arrhythmias. just a curiosity, on movie two there is some turbolence in the LVOT which could be... On: 02/07/2011 By: gquarta Read more?

Re: Number 11-02: Another cause of mitral regurgitation
This is a really interesting case and indeed one that raises many questions and concerns. A not infrequent finding on CMR LGE images is the suggestion of an enhanced left atrial wall- and whether this is a true finding or... On: 02/02/2011 By: rohanlon Read more?

Number 11-02: Another cause of mitral regurgitation
Great case.the image below is from the random stills (rather than movies) on scmr sub pages.This was sarcoid involvement of both papillary muscles. Interestingly, no compacted myocardial involvement in this one. The LA wall in the case... On: 01/30/2011 By: moon Read more?